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Inspection on 13/12/06 for Orchard Manor Nursing Home

Also see our care home review for Orchard Manor Nursing Home for more information

This inspection was carried out on 13th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is in a pleasant and peaceful setting but is only two miles from the centre of Chester. The home was purpose built and most bedrooms are very spacious. All parts of the building are accessible for residents who use a wheelchair. The home employs an activities organiser and she provides a range of social and recreational opportunities for residents. A high proportion of staff have either a nursing qualification or a national vocational qualification in care.

What has improved since the last inspection?

New care plans have been developed and they make it easier to access important information about residents` needs and how the needs are met.A great deal of work has been done since the last inspection to bring medicines management up from a poor standard to a very good standard. Bedrails were all protected by padded bumpers to ensure that residents are not at risk of entrapment or other injury from the rails. Two bathrooms are being refurbished. There has been a great improvement in keeping staff records. The administrator is making good progress in sending for enhanced Criminal Records Bureau disclosures for staff who did not already have them. There is an additional member of care staff on duty between 12 midday and 6 pm to ensure that residents` needs are met. There has been more training for staff and this training has been recorded on a training matrix so that the management team can identify which staff have attended training and who still needs to attend or is due for an update.

What the care home could do better:

The recording of pre-admission assessment could be improved to ensure that staff have as much information as possible about new people being admitted to the home. There is still room for improvement in the care plans. In some cases there was a significant delay between the resident being admitted and a plan of care being written. The records of wound care need to be clearer. Review the arrangements for serving lunch to ensure that residents receive a hot meal. Keep more thorough records of any complaints received and of what action was taken to address the complaint. Make sure that there are enough cleaners on duty each day to maintain a good standard of cleanliness at all times. Ensure that residents` clothing is taken good care of in the laundry and replace any towels and facecloths that are worn out. Complete the refurbishment of bathrooms so that there are facilities available to meet the needs of all residents. Continue to monitor the number of care staff needed to meet the dependency of residents and make sure that residents do not have to wait a long time when they need attention.Continue to develop auditing systems to show that performance is monitored and that the home consults with all interested parties, including the staff, and identifies where improvements can be made.

CARE HOMES FOR OLDER PEOPLE Orchard Manor Nursing Home Greenacres Court Acres Lane Upton, Chester Cheshire CH2 1LY Lead Inspector Wendy Smith Unannounced Inspection 13th December 2006 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Manor Nursing Home Address Greenacres Court Acres Lane Upton, Chester Cheshire CH2 1LY 01244 376568 01244 399855 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Fordent Properties Limited Caroline Love Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to a maximum of 53 service users in the OP (older persons) category may be accommodated. 1st August 2006 Date of last inspection Brief Description of the Service: Orchard Manor is a care home providing nursing care and personal care for up to 53 older people. It is owned by Fordent Properties Ltd, a family business. The home is a purpose built property in a residential area approximately two miles from Chester city centre. The extensive grounds are shared with an adjoining sheltered housing complex which is owned by the same company. The home’s fees range from £390 to £600 per week. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place on 13th December 2006 and lasted six and a half hours. The visit was carried out by two inspectors. An expert by experience was also present. The Commission for Social Care Inspection are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are currently testing a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘expert by experience’ used in this report describes a person who has been appointed by Help the Aged, under the direction of the Commission for Social Care Inspection, to take part in the inspection of services for older people. This visit was just one part of the inspection. Before the visit the home manager was asked to complete a questionnaire to provide up to date information about services in the home. Questionnaires were made available for residents and their families to find out their views. Other information received since the last key inspection was reviewed. During the visit, various records and the premises were looked at. Most of the residents and a number of relatives were spoken with and they gave their views about the home. What the service does well: What has improved since the last inspection? New care plans have been developed and they make it easier to access important information about residents’ needs and how the needs are met. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 6 A great deal of work has been done since the last inspection to bring medicines management up from a poor standard to a very good standard. Bedrails were all protected by padded bumpers to ensure that residents are not at risk of entrapment or other injury from the rails. Two bathrooms are being refurbished. There has been a great improvement in keeping staff records. The administrator is making good progress in sending for enhanced Criminal Records Bureau disclosures for staff who did not already have them. There is an additional member of care staff on duty between 12 midday and 6 pm to ensure that residents’ needs are met. There has been more training for staff and this training has been recorded on a training matrix so that the management team can identify which staff have attended training and who still needs to attend or is due for an update. What they could do better: The recording of pre-admission assessment could be improved to ensure that staff have as much information as possible about new people being admitted to the home. There is still room for improvement in the care plans. In some cases there was a significant delay between the resident being admitted and a plan of care being written. The records of wound care need to be clearer. Review the arrangements for serving lunch to ensure that residents receive a hot meal. Keep more thorough records of any complaints received and of what action was taken to address the complaint. Make sure that there are enough cleaners on duty each day to maintain a good standard of cleanliness at all times. Ensure that residents’ clothing is taken good care of in the laundry and replace any towels and facecloths that are worn out. Complete the refurbishment of bathrooms so that there are facilities available to meet the needs of all residents. Continue to monitor the number of care staff needed to meet the dependency of residents and make sure that residents do not have to wait a long time when they need attention. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 7 Continue to develop auditing systems to show that performance is monitored and that the home consults with all interested parties, including the staff, and identifies where improvements can be made. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed to ensure that their needs can be met at the home. EVIDENCE: One of the inspectors looked at the records for recently admitted residents. These showed that the residents had been assessed before they were admitted to Orchard Manor, however the recording of the assessment could be improved to provide better information for staff. This was discussed with the manager who confirmed that a new assessment form is due to be introduced in the near future. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The documentation of care has improved but could still be better. The health needs of residents are met and the management of medicines has greatly improved. EVIDENCE: One of the inspectors looked at care plans for seven residents, mainly concentrating on the most frail or poorly residents who need a lot of care. The care plans were generally better written but were not always signed or dated. It was sometimes several days after admission before a care plan was written, for example for a resident at risk of poor nutrition. Reviews were not always completed on time. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 11 Wound care records are not in the care plans but in a separate folder for each floor of the home. The manager said that this was done for auditing purposes. There did not appear to be any serious pressure sores but the documentation was not good and the quality of the photographs was poor. The inspectors questioned whether the treatment being provided for grade 2 pressure sores was appropriate. It would be a great asset to the home if one of the nurses could develop expertise in tissue viability and the manager said that they were planning this. In general there was evidence that the health and personal care needs of residents were met however the following observations were made to the home manager. Fluid balance charts were not always well completed, for example on one chart nothing had been filled in until 3 pm and the total showed that the resident had only had 350 mls of fluid through the 24 hour period. A new resident has Parkinson’s Disease and staff did not appear to fully understand his needs. Medicines were looked at on all three floors of the home. It was evident that a great deal of work had been put into improving the standards in all areas of medicines management. The recording on medicine administration record sheets was excellent. The storage rooms were clean and tidy and all old stock had been disposed of. There were stock balances of all medicines in the home and these were checked weekly. The home has a new controlled drugs cupboard. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social activities are provided for residents and residents are happy with the quality of their meals although service could be improved. EVIDENCE: The expert by experience spoke with many residents and observed the serving of lunch in the dining room. Most residents expressed their satisfaction with daily living arrangements and particularly enjoyed the activities. There are social needs assessments in residents’ care plans but these need to be more explicit, for example in some cases the plan of care is ‘to find out the resident’s interests’, but this is not followed up by recording what their interests are. One resident said that she had made some good friends at the home. Visitors are welcomed at any reasonable time and some relatives are closely involved with the care of their loved one. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 13 At lunchtime the expert by experience considered that the plastic tablecloths were not very homely and there were not enough serviettes or any salt and pepper on the tables. The soup was served mainly in cups rather than bowls. The plates were cold (this was also commented on by a resident who completed a survey form). The way in which the meal was served out involved staff going around the room with tureens, and this meant that the food had gone cold by the time the residents had a complete meal. The wait was even longer for those residents who needed assistance with their meal and their food was not covered over while they waited. The expert by experience also commented that the staff who were assisting residents with their meal used tissues to clean up any mess and left these dirty tissues on the table while residents were having their meal, which was not very pleasant. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. More thorough records should be kept to show that complaints are acted upon. Arrangements to ensure that residents are protected from abuse have been made more robust. EVIDENCE: Complaints made to the home are recorded on a complaints form and kept in a folder. The records showed that there had been eleven complaints in the last year. The records were poor in quality. Some were undated and referred to records kept in other files. They did not provide a good record of what the complaint was and how it had been addressed. This does not mean that the complaints were not addressed, and other evidence provided by the home during the year did show that the registered person had fully addressed a complaint brought through the Commission for Social Care Inspection. Adult Protection policies and procedures have been updated to reflect best practice. There has been regular staff training events and nearly all staff have now had this training. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is spacious, comfortable and accessible for wheelchairs. The standard of cleanliness is not consistent and improvements are needed in the care of laundry. EVIDENCE: The home was purpose-built and provides spacious accommodation for residents that is accessible for wheelchairs. Most bedrooms exceed the national minimum standards for space and most have en-suite facilities. The grounds are well-maintained and there are pleasant outdoor sitting areas for residents. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 16 Two bathrooms have been refurbished and the third is almost complete, however a resident who told the inspector in August 2006 that she is unable to have bath as she is very large, is still unable to have a bath or shower as the facilities provided do not accommodate very large or very disabled people. The manager said that they are still awaiting the installation of a shower which will address these difficulties and the responsible individual had confirmed that the wrong shower had been delivered. The expert by experience pointed out to the home manager a shower tray in an en suite bathroom that was cracked and potentially hazardous. Two relatives commented that the home is not always kept clean and there are no cleaners sometimes at the weekend. The housekeeper said that there was a shortage of cleaners and sometimes staff are taken off cleaning to help in the laundry, kitchen or with care. They were finding it very difficult to recruit cleaning staff but they were doing their best and ensuring that the most important tasks are carried out. On the day of the visit most areas of the home were clean and there were no unpleasant odours. The expert by experience spent time looking at the laundry. She found that there was no method of soaking badly stained clothing as there were no plugs for the sink. Some of the clothing she saw was badly stained and creased; towels and facecloths were badly worn and frayed and some had holes in. Neither clothing nor bedding was ironed and the ironing facilities were poor. There was a large amount of unidentified clothing. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels have increased but some residents felt they waited too long for attention. Action is being taken to address identified shortcomings in recruitment procedures and staff training. EVIDENCE: Since the last inspection an additional member of care staff has been put on the rota between 12 midday and 6 pm. There were much fewer nurse call bells ringing than during the last visit, however some residents commented that they have to wait up to 20 minutes for attention, and at 11:30 am two residents were still waiting for assistance to get out of bed. The manager needs to keep staffing levels under review to ensure that the number of staff on duty reflects the dependency needs of residents. The home employs 14 nurses, 33 care staff and 13 ancillary staff. 18 carers have a national vocational qualification in care or equivalent and three others have nearly completed NVQ. Staff rotas showed that the staffing numbers are maintained with use of agency staff when required. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 18 There are still a small number of staff who do not have a Criminal Records Bureau disclosure, and others who have a standard disclosure when an enhanced is required. The home has a new administrator and she has been working through the records and sending for the required disclosures. She has already made good progress and said that she hopes to have all the records complete in the near future. Staff files were looked at for five people. Three of these were very good and contained all of the required information. The other two were still awaiting Criminal Records Bureau disclosures. The administrator confirmed that she is aware of all the recruitment checks required for new staff and these are now being completed before staff start working at the home. There was evidence that a considerable amount of training has been provided for staff over recent months. A training matrix has been developed and all recent training has been recorded on this. There are still some gaps where it was not clear whether staff had attended mandatory training, but further training sessions were planned and good progress had been made in addressing shortfalls. There were also induction and supervision records for new staff. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some quality monitoring is taking place and health and safety issues that were identified at the last visit have been addressed. EVIDENCE: The home manager is a registered nurse and is registered with the Commission for Social Care Inspection. She has recently completed NVQ level 4 in management. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 20 The accident book was very well completed but monthly auditing of accidents consisted only of recording numbers and did not show that the causes or circumstances of accidents had been looked at. There was a timetable for the auditing of care plans but no records were available to show what the audits had found. The auditing of medicines was very good. Records available indicated that the last staff meeting had been in March 2006. A resident satisfaction survey was carried out in February 2006. The responsible individual carries out regular monitoring visits to the home. Since the last key inspection a copy of the home’s fire risk assessment has been sent to the Commission for Social Care Inspection and all staff have taken part in fire drills. Repairs to the passenger lifts have been completed. Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 2 X X 3 Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP21 Regulation 23(2)(j) Requirement Complete the refurbishment of bathrooms so that suitable shower/bathing facilities are available for all residents. Make sure that there are enough domestic staff on duty each day to keep all parts of the home clean and tidy and look after residents’ clothing. Continue to monitor the number of care staff needed to meet the dependency of residents and make sure that residents do not have to wait a long time when they need attention. Continue with the programme of staff training to ensure that all staff are up to date with mandatory training to promote the health, safety and welfare of residents. Timescale for action 31/01/07 2 OP26 23(2)(d) 19/12/06 3 OP27 18(1)(a) 19/12/06 4 OP30 18 31/01/07 Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 23 5 OP33 24 Continue to develop auditing and monitoring systems to show that performance is monitored and that the home consults with all interested parties, including staff, and identifies where improvements can be made. 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Complete all of the forms and documents in the care plans accurately to provide evidence of a full assessment and of the care that has been given to residents. Ensure that residents’ clothing is taken good care of in the laundry Replace any towels and facecloths that are worn out. Review the arrangements for meals service to ensure that all residents can enjoy a meal that is hot and freshly served out. Keep more thorough records of any complaints received and of what action was taken to address the complaint. 2 3 4 OP10 OP10 OP15 5 OP16 Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Orchard Manor Nursing Home DS0000018788.V317655.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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